Influence of land-use patterns on benthic diatom communities and water quality in the tropical Monjolinho hydrological basin, São Carlos-SP, Brazil

The objective of this study was to determine the effects of land-use patterns on both diatom community composition and water quality in tropical streams during the dry season. Benthic diatom collections and water quality sampling were done 4 times at 10 sites. A suite of environmental variables that varied with human land-use pattern was assessed to find the combination of variables that best explained patterns of diatom community composition. Canonical Correspondence Analysis (CCA) was used to determine environmental gradients along which species were distributed. A clear relationship between both benthic diatom communities and water quality and land-use pattern was observed with species richness, diversity and evenness, decreasing significantly from the agricultural and forest area to the urban area. Upstream, forested, agricultural sites, with good water quality (BOD5 = 0.9 to 2.6 mg∙ℓ-1, DO = 6.8 to 8.2 mg∙ℓ-1, phosphate = >2 to 4.7 μg∙ℓ-1), were characterised by Thalassiosira weissflogii, Orthoseira dentroteres, Meridion anceps, Melosira varians, Diatoma spp, Diadesmis contenta, Eunotia papillo, E. bilunaris, E. intermedia, E. sudetica, Aulacoseira alpigena, A. ambigua, Cymbopleura naviculiformis and Stauroneis phoenicenteron. Urban sites, with medium to bad water quality (BOD5 = ~7 mg∙ℓ-1, DO = ~7 mg∙ℓ-1, phosphate = 12.6 to 83.1 μg∙ℓ-1), were characterised by Diadesmis dissimilis, Frustulia rhomboids, Nitzschia scalaris, Nitzschia linearis, Cyclotella pseudostelligera Neidium ampliatum, N. affine, Encyonema silesiacum, E. neomesianum,Aulacoseira granulata, Navicula cryptotenella, Pinnularia legumen, P. gibba, P. divergens, Surirella linearis, S. robusta, and Achnanthidium minutissimum. Downstream urban sites, with very bad water quality (BOD5 = 19.5 to 26.2 mg∙ℓ-1, DO = 0.4 to 1.9 mg∙ℓ-1, phosphate = 142.5 to 248.7 μg∙ℓ-1), were characterised by Gomphonema parvulum, G. accuminatum, Nitzschia palea, Nupela praecipua, Sellaphora pupula, Planotidium lanceolata, Fallacia monoculata and Pinnularia subcapitata. Diatom communities demonstrated potential for acting as indicators of changes in water quality due to changes in catchment land-use patterns.Keywords: land-use, benthic diatoms, environmental gradient, agricultural, forests, urba

The medical licensing examination debate

National licensing examinations are typically large-scale examinations taken early in a career or near the point of graduation, and, importantly, success is required to subsequently be able to practice. They are becoming increasingly popular as a method of quality assurance in the medical workforce, but debate about their contribution to patient safety and the improvement of healthcare outcomes continues. A systematic review of the national licensing examination literature demonstrates that there is disagreement between assessment experts about the strengths and challenges of licensing examinations. This is characterized by a trans-Atlantic divide between the dominance of psychometric reliability assurance in North America and the wider interpretations of validity, to include consequences, in Europe. We conclude that the debate might benefit from refocusing to what a national licensing examination should assess: to achieve a balance between assessing a breadth of skills and the capacity for such skills in practice, and focusing less on reproducibility

The transition from medical student to junior doctor: today's experiences of Tomorrow's Doctors.

CONTEXT Medical education in the UK has recently undergone radical reform. Tomorrow's Doctors has prescribed undergraduate curriculum change and the Foundation Programme has overhauled postgraduate education. OBJECTIVES This study explored the experiences of junior doctors during their first year of clinical practice. In particular, the study sought to gain an understanding of how junior doctors experienced the transition from the role of student to that of practising doctor and how well their medical school education had prepared them for this. METHODS The study used qualitative methods comprising of semi-structured interviews and audio diary recordings with newly qualified doctors based at the Peninsula Foundation School in the UK. Purposive sampling was used and 31 of 186 newly qualified doctors self-selected from five hospital sites. All 31 participants were interviewed once and 17 were interviewed twice during the year. Ten of the participants also kept audio diaries. Interview and audio diary data were transcribed verbatim and thematically analysed with the aid of a qualitative data analysis software package. RESULTS The findings show that, despite recent curriculum reforms, most participants still found the transition stressful. Dealing with their newly gained responsibility, managing uncertainty, working in multi-professional teams, experiencing the sudden death of patients and feeling unsupported were important themes. However, the stress of transition was reduced by the level of clinical experience gained in the undergraduate years. CONCLUSIONS Medical schools need to ensure that students are provided with early exposure to clinical environments which allow for continuing 'meaningful' contact with patients and increasing opportunities to 'act up' to the role of junior doctor, even as students. Patient safety guidelines present a major challenge to achieving this, although with adequate supervision the two aims are not mutually exclusive. Further support and supervision should be made available to junior doctors in situations where they are dealing with the death of a patient and on surgical placements

The International Landscape of Medical Licensing Examinations: A Typology Derived From a Systematic Review

Background National licensing examinations (NLEs) are large-scale examinations usually taken by medical doctors close to the point of graduation from medical school. Where NLEs are used, success is usually required to obtain a license for full practice. Approaches to national licensing, and the evidence that supports their use, varies significantly across the globe. This paper aims to develop a typology of NLEs, based on candidacy, to explore the implications of different examination types for workforce planning. Methods A systematic review of the published literature and medical licensing body websites, an electronic survey of all medical licensing bodies in highly developed nations, and a survey of medical regulators. Results The evidence gleaned through this systematic review highlights four approaches to NLEs: where graduating medical students wishing to practice in their national jurisdiction must pass a national licensing exam before they are granted a license to practice; where all prospective doctors, whether from the national jurisdiction or international medical graduates, are required to pass a national licensing exam in order to practice within that jurisdiction; where international medical graduates are required to pass a licensing exam if their qualifications are not acknowledged to be comparable with those students from the national jurisdiction; and where there are no NLEs in operation. This typology facilitates comparison across systems and highlights the implications of different licensing systems for workforce planning. Conclusion The issue of national licensing cannot be viewed in isolation from workforce planning; future research on the efficacy of national licensing systems to drive up standards should be integrated with research on the implications of such systems for the mobility of doctors to cross borders

A spatial assessment of stream-flow characteristics and hydrologic alterations, post dam construction in the Manyame catchment, Zimbabwe

The global hydrologic regime has been intensively altered through activities such as dam construction, water abstraction, and inter-basin transfers. This paper uses the Range of Variability Approach (RVA)  and daily stream flow records from nine gauging stations to characterize stream-flow post dam construction in the Manyame catchment, Zimbabwe. We identify which variables continue to be altered, upstream and at different distances downstream, to distinguish sections with the highest  potential for ecological disruption and to understand how hydrological alterations dissipate downstream of dams. Our results indicate that different sections of the same river have different stream-flow  characteristics post dam construction. The most adverse effects of dams were on downstream stretches of the river which were characterized by low flows, extreme low flows and an increased number of zero-flow days. These differences reflect the  operation rules of the Manyame catchment dams. While the change in stream-flow characteristics is  apparent in the 0–10 km range, it is slightly felt in the 11–20 km range and totally disappears at distances >20 km downstream of dams. These changes in stream characteristics, and that damming is only restricted to the upper third of the catchment, make the hydrologic fragmentations in the catchment minor. However, the continued hydrologic alterations post dam construction raise important concerns about the interactions of hydrology with other factors like sediment deposition upstream of dams and climate change. We  recommend that catchment managers target enhancing the natural flow variability of the river instead of meeting target flows.Keywords: damming, range of variability approach, stream-flow characteristic

Reporting accuracy of packed lunch consumption among Danish 11-year-olds differ by gender.

Background: Packed lunch is the dominant lunch format in many countries including Denmark. School lunch is consumed unsupervised, and self-reported recalls are appropriate in the school setting. However, little is known about the accuracy of recalls in relation to packed lunch. Objective: To assess the qualitative recall accuracy of self-reported consumption of packed lunch among Danish 11-year-old children in relation to gender and dietary assessment method. Design: A cross-sectional dietary recall study of packed lunch consumption. Digital images (DIs) served as an objective reference method to determine food items consumed. Recalls were collected with a lunch recall questionnaire (LRQ) comprising an open-ended recall (OE-Q) and a pre-coded food group prompted recall (PC-Q). Individual interviews (INTs) were conducted successively. The number of food items was identified and accuracy was calculated as match rates (% identified by DIs and reported correctly) and intrusion rates (% not identified by DIs but reported) were determined. Setting and subjects: Three Danish public schools from Copenhagen. A total of 114 Danish 11-year-old children, mean (SE) age=11.1 (0.03), and body mass index=18.2 (0.26). Results: The reference (DIs) showed that girls consumed a higher number of food items than boys [mean (SE) 5.4 (0.25) vs. 4.6 (0.29) items (p=0.05)]. The number of food items recalled differed between genders with OE-Q recalls (p=0.005) only. Girls’ interview recalls were more accurate than boys’ with higher match rates (p=0.04) and lower intrusion rates (p=0.05). Match rates ranged from 67–90% and intrusion rates ranged from 13–39% with little differences between girls and boys using the OE-Q and PC-Q methods. Conclusion: Dietary recall validation studies should not only consider match rates as an account of accuracy. Intrusions contribute to over-reporting in non-validation studies, and future studies should address recall accuracy and inaccuracies in relation to gender and recall method